Objective: This study proposes to expand the understanding of how insurance coverage, recipient incomes, immunosuppression prices, Medicaid, and state-specific support programs interact to significantly affect long-term kidney transplantation graft survival. Specific Aims: Elsewhere, we have demonstrated that in the absence of Medicare's immunosuppressive medication coverage, low-income recipients had significantly greater graft loss. Here we ask: 1) whether recipient income and immunosuppression insurance affect graft survival among black recipients differently than white; 2) whether differences in state Medicaid regulations and state programs such as the Missouri Kidney Program have ameliorated the importance of insurance as a determinant of graft survival among low income recipients; and 3) whether the cost of the immunosuppressive regimen correlates with graft survival. Methods: The project merges a) patient-level USRDS-provided data about the patient, transplant, immunosuppressive medications, graft survival, and cost; b) ZIP-code-level Census data socio-economic characteristics (Income, Education, and state-level data with details about Medicaid programs relevant to kidney transplantation and state-kidney-specific support programs. The project will illustrate the importance of each of these variables on graft survival using Kaplan-Meier plots of graft survival. The project will estimate each variable's importance in multivariate Cox Proportional Hazards model. Importance: The results of this project will provide some guidance to both Medicare and state policy-makers responsible for determining the length of immunosuppression coverage. Specifically, it will identify those patient characteristics for which insurance had the greatest historical impact. The results will also guide physicians in selecting among immunosuppressive medications with widely variable prices by identifying those patient groups for whom out-of-pocket price was an important determinant of long-term graft survival.